Haven is a non-clinical, calm, safe space in the community which provides: - Crisis prevention - A diversion from A&E for people in emotional distress - A key alternative for other more restrictive options for people in distress as part of the wider Bradford Crisis Care Pathway We are open every day of the year. www.thecellartrust.org.
WINNER - CRISIS & ACUTE CARE AWARD #MHAWARDS18
Haven is a non-clinical, calm, safe space in the community which provides: – Crisis prevention – A diversion from A&E for people in emotional distress – A key alternative for other more restrictive options for people in distress as part of the wider Bradford Crisis Care Pathway We are open every day of the year.
The aims are: – To provide a non-clinical, peer support lead alternative to more restrictive options for people in distress – To contribute to Bradford’s wider objectives in terms of no out of area placements, no inappropriate use of police cells and inappropriate use of S136s, reductions in A&E attendances due to mental health and improving the experience of people in distress – To provide a high quality, peer support lead service which ensures that people feel supported, understood and can develop news skills and confidence to manage their own mental health – To provide joined up support so people can access the right support at the right time. Haven has been operating since August 2016.
Our approach is one of integrated delivery and Haven is part of the jigsaw that makes up the wider acute and crisis care pathway. Originally established as a result of the Crisis Care Concordat, the partnership brings together Bradford District Foundation Care Trust, Bradford Council, the police, Yorkshire Ambulance, the 2 acute hospitals and 2 other VCS organisations. Haven is based in a community setting which is non-clinical and our clients describe it ‘more like your living room’ than anything else. We have an onsite (training cafe) which is a key part of the space that we use. Co-located we have a member of the Intensive Home Treatment Team and the Duty Social Worker. We also have a Citizen’s Advice Worker on site once a week. Lived expertise is at the heart of everything we do and the service is primarily delivered by paid peer support workers, with additional support from peer support volunteers.
What makes your service stand out from others?
There are lots of other Safe Spaces/Crisis Cafes in the country now which is brilliant but we believe that Haven offers a unique model of delivery. Haven is a lead by a 3rd sector organisation so the support that people receive is non-clinical and delivered in a calm, safe, community space by people with lived expertise but it is crucially also an integrated service with the success coming from its close partnership working. People tell us that the last thing they want when they are in distress is to be ‘passed from pillar to post’ so it was crucial for us to develop something that enabled a joined up approach. As such, our front line delivery is peer support but we have a nurse from the Intensive Home Treatment team onsite, as well as a Duty Social Worker.
This enables us to ‘step up’ support, or enable smooth transitions to receive additional support if people need it without the ‘blockers’ that can result from traditional cross-agency referrals. It also means that our service benefits from the additional clinical governance (by hooking into BDCFT infrastructure) and can deliver at a higher level of acuity than many traditional crisis cafes. We operate as a true team right from the top in terms of leadership and governance with clear commitment from all of the partners involved. We all have common goals and values, and crucially one of these is around continuous improvement. Since opening in August 2016 our service has not stayed still and we look at the data and innovate on a monthly basis. This has also lead to a number of new developments including piloting peer support in A&E and, most recently, participating in a national research programme (ENRICH) piloting peer support, supporting discharge following multiple admissions to inpatient units. We have also now been successful in securing DoH capital funding which will allow us to develop a digital offer for our safe spaces – so that people have the option of access to support via instant messenger or a Skype type application.
How do you ensure an effective, safe, compassionate and sustainable workforce?
As a VCS organisation it can be hard to fund continuous, good quality training but this has been made possible through our brilliant partnerships with BDCFT and BMDC. Our training is delivered on a regular basis which means that over and above core training the team also access specialist training via the Trust or we can agree additional topics based on things that are emerging in terms of our clients and how they need to be supported. We are also very proud that our own team are now developing their own training – particularly around delivering individual and group peer support which we are now using to induct new staff and peer support volunteers. Our team is primarily made up of peer support workers and we are proud to see how colleagues have progressed in their skills and experience during their time here, leading to promotions within the team. We have also had peer support volunteers (clients from our employment service) who have gone on to gain paid employment within the team. As with all aspects of our work, we work hard to continuously improve how we support and develop our team to ensure that they can stay well and develop their skills, in what can be a very challenging environment to work.
We have enhanced our practice as a result of direct input from the team, including ‘In-work Wellness Plans’ and we have recently established a Bradford-wide Peer Support Group for people working in peer support (across a range of organisations). Supervision is key, so as well as internal supervision, our team access external clinical supervision and can have fast tracked access to therapeutic support via BDCFT. The team also have twice daily huddles and monthly team meetings.
Quote: ‘Due to severe mental health problems as a teenager and young adult and then raising my kids and studying, I haven’t been in paid work for 18 years. When I saw the advert for the peer support role at Haven I just thought I’d have a go and didn’t really expect to even get an interview. I’d never had a formal job interview before so the whole process made me extremely anxious and nearly made me give up before I’d started. However, being offered and accepting the job was one of the best decisions I have ever made. My confidence has increased massively and I have done things that I never would have dreamed I was capable of. From becoming comfortable talking on the phone to giving talks at the college and university, the chances and opportunities to grow and develop my skills have been fantastic. I have done so many confidence building/assertiveness courses in my life but the one thing that has really helped has been finding employment where I feel capable, valued and respected.’
Quote: ‘As a service we can be really responsive to people’s needs and feedback and I love working somewhere that listens to the ideas of clients and staff members alike. I feel empowered and able to challenge and develop things within the service; I feel like I am encouraged to have a voice here and that that voice is heard and valued. This means a lot to me and has built up my confidence and self-esteem at work more than I ever thought.’
Who is in your team?
The following team operates 365 days per year which equates to 3 or 4 staff per shift: Team Leader – Band 5 equivalent – 1WTE Peer Support Lead – Band 5 equivalent – 0.8 WTE Senior Peer Support Worker – Band 4 equivalent – 0.7WTE Peer Support Worker – Band 3 equivalent – 0.6 WTE Peer Support Worker – Band 3 equivalent – 0.6 WTE Support Worker – Band 3 equivalent – 0.8 WTE Peer Support Worker – Band 3 equivalent – 0.8 WTE Peer Support Worker – Band 3 equivalent – 0.6 WTE
Joint Induction programme plus ongoing training Integrated team on site (peer support, IHT and social care) Data sharing agreement Integrated team Joint Safe Space Steering Group (all age) – multi agency Adult Safe Space Operations Meeting Frequent Attenders Meeting Pathways into Haven from First Response Service (single point of access), PLNs (A&E), Community Mental Health Team, Early Intervention in Psychosis, Intensive Home Treatment Team, discharge from Inpatient units, IAPT and Sanctuary (Mind in Bradford). Citizen’s Advice on site once a week Close links with a wide range of other VCS organisations including 1 day a week of Haven delivered at Project 6 (addiction service in Keighley) Part of a West Yorkshire and Harrogate STP Safe Space Group Pathways into The Cellar Trust Vocational Service Pathway into The Cellar Trust peer support groups
Do you use co-production approaches?
When the service was originally set up, it was designed based on existing feedback from a range of mental health services. We ensured that we had people with lived expertise as part of the Steering Group. Lived expertise (paid staff and volunteers) is at the heart of all of our delivery and our team. The team have a wide range of personal experiences and input into our continuous improvement approach (see staff feedback). The data and feedback from our service is reviewed on a monthly basis by The Cellar Trust Leadership Team, bi-monthly by the Board of Trustees and bi-monthly by the Joint Safe Space Steering Group so that we can see where we need to make improvements. Reports include data from the qualitative questionnaires, follow up phone calls and the self-rated distress scores, as well as other data around referrals.
In addition, Haven (alongside the other Safe Spaces) has recently been independently evaluated by Mental Health Strategies. All of the above means that we continue to evaluate and develop to make things better. One example of this is that we found that lots of people were attending Haven with similar needs for support, for example, challenges around harmful coping mechanisms and problems sleeping, so we developed a peer support lead ‘after care programme’. After running the first programme, 100% of attendees found that it was helpful and increased their confidence in managing their own mental health, however, they found 6 weeks too brief. We therefore added an additional 2 weeks to the programme. We also found that lots of people who were attending were hearing voices so we trained the team in Maastrict Interviewing.
Do you share your work with others?
Speaking at a range of conferences (alongside BDCFT and BMDC colleagues) including NHS Expo, Mental Health Workforce Conference, Mental Health Finance Conference and VCS Assembly Conference Media articles including recent article in The Guardian about out wider acute care pathway, appearances on BBC Look North etc. Positive Practice in Mental Health Guide Established Bradford-wide support group for peer supporters Part of the national ENRICH peer support network (first randomised control sample study into peer support in the world) Hosted a number of visits from CCGs, local authorities and other VCS organisations as well as a delegation from a mental health organisation in Japan
Outcomes and evaluation
Qualitative feedback questionnaire post session (anon) Pre and post session self-rated distress score – also taken during 24 hour and 7 day follow up calls Qualitative feedback via phone calls Over the past 12 months we have delivered: 1988 sessions of support (1-1 and telephone) 60% of the people attending have been referred due to suicidal or self harm ideation. The average cost of attending a general hospital due to self harm is £809 per person, per attendance (Lancet). Average 63% reduction in feelings of distress Examples of qualitative feedback: ‘I have been waiting since 2002 for help and have experienced difficulties accessing it. I feel very much today that I was listened to effectively and compassionately and am at last feeling hope.’ ‘Was really helpful talking to a professional who actually knows and understands how it feels. For the first time I felt totally understood’. ‘It’s helped so much, I don’t feel like I am alone and that what I am going through is normal. I have found things out I never thought about before to help cope with feelings of suicide.’ ‘I came in a total mess – suicidal – and the help and support was fantastic and strategies I can do now to cope with my mental illness.’
Wider evaluation of the Bradford system: No out of area bed placements for 3 years (saving £1.8 million per year) Engaged with 66 of A&E’s Frequent Attenders 32% reduction in regular attenders utilising Bradford Teaching Hospital’s A&E All data is considered on a monthly basis at the Safe Space Operations Meeting or the Joint Safe Space Steering Group. As above this information is used to drive service improvement, as well as to identify additional opportunities for development – or gaps in provision.
Has your service been evaluated (by peer or academic review)?
Haven has recently been independently evaluated alongside the 2 other Safe Spaces in Bradford by Mental Health Strategies. Winner of Crisis and Acute Award – National Positive Practice Mental Health Awards 2018.
Development and sustainability
The service was originally funded through the Vanguard. Due to its success, the commissioners (CCG) have agreed recurrent funding until at least 2021. The commissioners are fully bought into our system wide ways of working and attend the Joint Safe Space Steering Group. We are proud that our model for delivery is seen as leading in our local area: ‘Having strong diverse partnership is something Haven has clearly demonstrated and the impact of this has been extremely positive. Having a local service that wraps support, care and professionalism around individuals has enabled people to have their needs met by a multi-agency team. Haven is making a big difference – a truly exceptional service that is going from strength to strength together with partners, with a strong commitment to work together to improve people’s experiences.’ CEO, BDCFT ‘
Much is talked about effective partnership work. It’s harder to find impressive examples. The Haven is one such. Built from a passionate shared commitment to get alongside people at moments of personal crisis; concern for hierarchies, formal job titles and institutional budgets are pushed to the background. At the foreground is the desire to do what it takes to build people’s personal resilience and independence.’ CEO, BMDC Due to this partnership approach having been so successful, there have been a number of new developments including peer support workers from The Cellar Trust embedded within the IAPT service (My Wellbeing College) as well as the new ENRICH programme. In the coming months we will also be developing an integrated employment service for the District. This shows that this approach is being embedded across the wider system and is not reliant on single individuals.
What aspects of your service would you share with people who want to learn from you?
There are lots of lessons we have learnt along the way. The Haven service is very different to how we set it up in August 2016 as we have evolved our model according to how it has worked best for people, and as part of the wider system. We have learnt lessons in terms of: The make-up of the team How to manage referrals and demand How to best evaluate our impact Different support needs that people have and how to meet these The best way to support a work force made up of peer supporters The pathways that should be in place We believe in the importance of sharing these lessons with others so they do not have to reinvent the wheel!
How many people do you see?
In the past year we have delivered 1988 sessions of support (1-1 face to face and telephone).
How do people access the service?
The service can be accessed via: First Response (single point of access) – which is self referral Intensive Home Treatment Team IAPT EIP Community Mental Health Teams PLNs in A&E As part of discharge from inpatient wards As the current referral routes are via NHS or social care services, they have already been triaged in terms of suitability before referral.
How long do people wait to start receiving care?
Almost everyone can access our service within 24 hours of referral. This depends on the time of day that they are referred.
How do you ensure you provide timely access?
In the main we do not have any need to prioritise individuals as people can access the service within 24 hours. 1st appointments are seen as the priority if needed.
Hours the service operates *
10am-6pm (365 days a year)
Bradford and Craven have a population of 586,800 people with an estimate of 6,200 in need of specialist mental health services. In Bradford District there is significant ethnic diversity, with some areas being amongst the highest in terms of poverty and deprivation in the UK. In Craven there are contrasting challenges of rural isolation.
586,800 over Bradford District and Craven
Commissioner and providers
Bradford City, Bradford District and Airedale, Wharfedale and Craven CCGs
The Cellar Trust in partnership with Bradford District Foundation Care Trust and Bradford Council